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Pharm test 3 lilk8to
Ch. 21, 23, 24 lilk8tob-Cardiac drugs
| Drug | Info |
|---|---|
| Drugs that increase myocardial contractility | inotropic |
| drugs that increase the rate at which the heart beats | chronotropic |
| drugs that accelerate conduction- electrical | dromotropic |
| Most commonly prescribed Cardiac Glycoside: | Digoxin |
| Cardiac glycosides help clients w/ heart failure by causing: | an increase in myocardial contractility (+inotropic) |
| Cardiac glycosides- MOA | Increase SV, Reduce heart size during diastole, decrease BP, increase coronary circulation |
| Tropic effects of Digoxin | +inotropic, -chronotropic(reduces HR), -dromotropic(prolongs referactory periods) |
| Digoxin (Lanoxin) drug class: | cardiac glycosides |
| Digoxin used for: | heart failure and atrial fibbrilation and flutter |
| Normal therapeutic level of Digoxin: | 0.5 to 2 ng/ml |
| Digoxin increases the force of contraction, thus: | increases the ejection fraction- as more blood is ejected w/ each contraction, there is less blood remaining in the ventricle (less pressure built up) |
| Cardiac glycosides SE: | dysrhythmias (brady or tachy), HA, confusion, colored vision, halo vision, flickering lights |
| Digoxin *classic* side effects: | bradycardia, N/V, colored vision, halo vision |
| What will increase digoxin's toxicity? | low potassium levels |
| Digoxin drug interactions: | K+ wasting diuretics (low K+=toxic), antiepileptics (decrease absorption) |
| What do you check before administering Digoxin? | serum K+ levels, and creatinine, Ca, Mg, Na |
| Large amts of ___ decrease digoxin absorption | bran |
| Need to do this before administer digoxin (not a serum level) | Take pulse- must 60-120 bpm |
| Antidote to digoxin | Digibind |
| Digoxin: increase or decrease urine: | increase |
| Digoxin- edema increased or decreased? | decreased |
| Digoxin- SOB, dyspnea & rales increased or decreased? | these are all decreased |
| Can you eat ice cream or antacids while on digoxin? | yes, but take dose 2 hrs before or after these products |
| What are the 3 antianginal classes? | nitrates, beta-blockers, calcium channel blockers |
| How do nitrates work as antianginals? | dilate constricted coronary arteries- increases O2 & nutrient supply to heart muscle |
| Nitroglycerin (Nitrostat) drug class: | nitrate- antianginal |
| Isosorbide (Imdur) drug class: | nitrate- antianginal |
| Procardia drug class: | nitrate- antianginal |
| nitrates used for: | coronary artery spasms, narrowed arteries from atherosclerosis |
| most common side effect from nitrates for anginal pain: | headache most common, also tachycardia, postural hypotension |
| Which antianginal agent has a tolerance develop? | nitrates if taken around the clock |
| How do beta-blockers work for anginal pain? | slow the HR (-chrono), decrease myocardial contractility (-ino) |
| Beta blockers chronotropic and inotropic effect are both: | negative |
| Beta blockers used for: | angina & MI, hypertension |
| Atenolol drug class: | Beta blocker (antianginal) |
| Metaprolol (Lopressor) drug class | beta blocker (antianginal) |
| Calcium channel blockers work by: | potent peripheral vasodilating properties |
| CCBs decrease O2 demand by | causing peripheral artery vasodilation and by a neg. inotropic action (-contractility) |
| CCBs effect on BP: | reduced from dilated peripheral vessels |
| CCBs used for: | angina, hypertension, supraventricular tachycardia, migraines, Raynaud's disease |
| CCBs Side effects: | hypotension, palpitations, heart failure, peripheral edema, constipation, flushing, wheezing |
| Diltiazem drug class: | calcium channel blockers d - antianginal |
| Nifedipine drug class: | calcium channel blockers n - antianginal |
| Verapamil drug class: | calcium channel blockers antianginal |
| These work by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload) | nitrates for anginal pain |
| These work by decreasing the calcim influx into the sm. muscle- vascular relaxation | calcium channel blockers for anginal pain |
| These work by slowing the HR and decreasing contractility, thereby decreasing oxygen demands | beta-blockers for anginal pain |
| Take sublingual nitroglycerine in what position (sitting, standing, laying down)? | Supine @ 1st sign of angina to prevent fainting |
| How do you store nitroglycerine? | In the dark in a non-warm place |
| What antianginal drug will always give you a headache? | nitrates |
| How do you take nitrates for anginal pain? | 1 sublingual every 5 minutes (up to 3) |
| Nitrate bottle can be open for how long? | 3 months- know it is too old if no longer burns |
| Which antianginal class will cause constipation? | Beta blockers |
| Which antianginal class can exacerbate respiratory conditions? | Beta blockers |
| Centrally acting alpha2 adrenergic agents are used for: | hypertension |
| SNS stimulation causes: | Increased HR & force of contraction, constriction of blood vessels, release of renin from kidney = hypertension |
| the alpha2 adrenergic agents reduce: | sympathetic outflow from the CNS, reducing BP |
| Clonidine (Catapres) drug class: | centrally acting alpha 2 adrenergic (antihypertensive) |
| Clonidine (Catapres) uses: | hypertension, managing opioid withdrawal, migraines |
| Clonidine (alpha2) side effects | hypotension, dry mouth, drowsy, constipation, HA, rebound hypertension |
| ACE inhibitors work by inhibiting: | the angiotensin converting enzyme (ang I ->II blocked) |
| What does angiotensin II do? | A potent vasoconstrictor & stimulator of aldosterone secretion - stimulates Na+ and H2O resorption, which can raise BP |
| ACE inhibitors are used for these conditions: | hypertension, used as adjunctive agents in treatment of heart failure, can stop left ventricular hypertrophy (seen post-MI) |
| ACE inhibitors are good for diabetic pts because: | have nephroprotective effect on kidney |
| Main side effect of ACE inhibitors | Nonproductive cough |
| When on ACE inhibitors, monitor what levels? | Serum Potassium levels |
| ACE inhibitors side effects | cough, loss of taste, proteinuria, hyperkalemia |
| ACE inhibitors- interactions: | NSAIDS reduce effects; K+sparing diuretics may cause hyperkalemia |
| Captopril (Capoten) drug class: | ACE inhibitors |
| What does Captopril (Capoten) do? | prevents left ventricular dilation (ventricular remodeling) after an MI |
| Calcium Channel blockers cause: | smooth muscle relaxation by blocking the binding of calcium to its receptors (prevents contraction) |
| deltiazem drug class | calcium channel blockers |
| nifedipine drug class: | calcium channel blockers |
| verapamil drug class: | calcium channel blockers |
| Vasodilators work: | directly on arteriolar smooth muscle to cause relaxation |
| Vasodilators do NOT work through : | adrenergic receptors |
| Vasodilator uses: | hypertension, restore hair growth |
| Vasodilator side effects: | dizziness, HA, anxiety, edema, nasal congestion, tachycardia, dyspnea, N/V |
| hydralazine hydrochloride (Apresoline) drug class: | vasodilators |
| when is hydralazine hydrochloride (apresoline) used? | essential hypertension (no known cause), injectable for hypertensive emergencies |
| What antihypertensive should not be 1st line, and why? | ACE-inhibitors, because of their serious side effects (may cause acute renal failure, hyperkalemia, proteinuria) |
| Use ACE-inhibitors cautiously if have: | hyperkalemia, HF, reduced renal function |
| When should you take alpha blockers (time of day) | bedtime- sleep through hypotensive effects |
| These can cause exacerbation of respiratory diseases- asthma, bronchospasm COPD: | nonselective beta-blockers |
| how do nonselective beta blockers exacerbate respiratory diseases? | their negative inotropic (lower contractility) effect |
| Angiotensin II receptor blockers work by: | blocking vasoconstriction and the secretion of aldosterone |
| Difference between ARB's and ACE inhibitors | ACE has cough, ARB doesn't |
| losartan (Cozaar) drug class: | Angiotensin II receptor blockers (ARB's) |
| How long for alpha blockers to work? | 4-6 weeks |
| On ACE inhibitors, should NOT take what supplement? | potassium |
| With ARB's, report what: | any unusual SOB, dyspnea, weight gain, chest pain, palpitations |
| Something pts on vasodilators should do daily: | weigh self |
| What do loop diuretics block? | chloride & sodium resorption |
| Loop diuretics cause dilation of: | the blood vessels of the kidneys, lungs, and the rest of the body |
| Loop diuretics- slow or fast onset? | rapid onset of action |
| Side effects of Loop Diuretics | hypokalemia, photosensitivity, aplastic anemia |
| Don't take _____ with loop diuretics | NSAIDS (they have the opp. effect on prostaglandin activity) |
| Furosemide (Lasix) drug class | loop diuretics |
| Furosemide (Lasix)- loop diuretic used for: | managing pulmonary edema & edema from HF, liver disease, nephrotic syndrome & ascites, hypertension from HF |
| Potassium sparing diuretics cause: | sodium and water to be excreted and potassium to be retained |
| Spironolactone (Aldactone) drug class: | K+ sparing diuretic |
| How does spironolactone (Aldactone) work? | competitively binds to aldosterone receptors & therefore blocks the resorption of Na and H2O |
| Spironolactone (Aldactone) used for: | hyperaldosteronism, hypertension, reversing K+ loss from Kaliuretic diuretics |
| K+ sparing diuretics - SE: | gynecomastia, amenorrhea, post-menopausal bleeding |
| Drug interactions- K+ sparing diuretics | No ACE-inhibitors or K+ supplements (can cause hyperkalemia), no lithium (lithium toxicity), NSAIDS decrease blood flow to kidneys |
| Monitor what when no Spironolactone (Aldactone) | K+ levels |
| Thiazides: uses | adjunct agents in the management of HF, hepatic cirrhosis, and edema |
| Thiazides work by inhibiting: | sodium, potassium & chloride resorption |
| Thiazides - side effects | dizziness, HA, blurred vision, pancreatitis, photosensitivity, hypokalemia, hyperglycemia, hyperuricemia |
| Thiazides - drug interactions | +digoxin-> digoxin toxicity; hypokalemia ; hypoglycemics-> antagonistic (reduced effect) |
| hydrochlorothiazidine (HydroDIURIL) drug class: | Thiazide diuretic |
| Diabetics taking ____ or _____ diuretics should closely monitor their blood sugar levels because these drugs can raise them. | thiazide and/or loop diuretics |
| Signs and symptoms of hypokalemia: | muscle weakness, constipation, irregular HR, lethargy |
| least expensive & most commonly used diuretics: | Thiazide diuretics (hydroDIURIL) |
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lilk8tob
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